Mental health is different from general health as in certain circumstances mentally ill people may not be in a position to make decisions on their own. Those who suffer rarely get access to appropriate medical treatment as their families try to hide their condition out of a sense of shame. Over 300 million people are estimated to suffer from depression, equivalent to 4.4% of the world's total population. According to a study conducted by the National Institute of Mental Health and Neurosciences, 1 in 40 and 1 in 20 people are suffering from the past and current episodes of depression in India. In spite of this big burden of mental health issues, unfortunately, it continues to be misunderstood in developing countries like India. The new Mental Healthcare Act 2017 rescinds/revoked the existing Mental Healthcare Act 1987 which had been widely criticized for not recognizing the rights of a mentally ill person.

Introduction: Epidural fibrosis (EF) contributes to unsatisfactory relief of symptoms and failed back syndrome after spine surgery. EF around the nerve root can be more refractory to treatment than the original disc herniation itself. Reoperation on the scar can produce more scarring. Few studies have been conducted regarding the type of material to be used for decreasing EF. Materials and Methods: The prospective randomized comparative study was conducted in the Department of Neurosurgery and Radiodiagnosis, of a tertiary care hospital. Informed and written consent was obtained. Patients previously unoperated with symptoms and radiological features of lumbar spinal canal stenosis were included in the study. Fifteen patients were assigned to Group A (free fat graft) and 15 patients in Group B (Gelfoam group). Postoperatively, at 3 and 6 months, clinical outcome was evaluated and EF was assessed on CE-MRI. Results: Age and sex were comparable in both groups. The pain relief at 3 and 6 months was more in Group A as compared to Group B. In Group A, on CEMRI at 3 months, 87% of patients had none to mild fibrosis, with none had extensive fibrosis. The CEMRI at 6 months showed no increase in fibrosis. In Group B, 80% of patients had none to mild fibrosis at the end of 3 months. At 6 months, 13.3% patients had extensive fibrosis. The extent of EF was found to be statistically significant at 6 months postsurgery. Conclusion: Use of free fat graft at laminectomy site helps in reducing EF.

Background: The Bethesda system is a uniform reporting system for thyroid cytology that facilitates the clarity of communication among cytopathologists, radiologists, and surgeons and facilitates cytohistologic correlation for thyroid diseases. Objective: This study was carried out to evaluate thyroid lesions by fine-needle aspiration cytology (FNAC) based on Bethesda system of reporting and to correlate the cytological findings with histopathology. Materials and Methods: A total of 606 patients with thyroid lesions were studied by FNAC at our institute between January 1, 2006, and January 31, 2016, and results were compared with histopathology wherever possible. Results: Based on the Bethesda system of classification of thyroid lesions, out of 580 satisfactory samples; 501 lesions were diagnosed as benign (Group 1), five were in category of atypical follicular lesion of atypia undetermined significance (Group 2), 55 were diagnosed as suspicious for follicular neoplasm (Group 3), 7 as suspicious for malignancy (Group 4), and 12 cases were malignant (Group 5). 26 aspirates were nondiagnostic even after reaspiration. In the present study, cytohistopathological correlation was done in 148 benign and 18 malignant lesions. The sensitivity of FNAC was 85.7%, specificity 98.6%, and diagnostic accuracy 97.7%. Conclusion: Reviewing the thyroid FNAs with the Bethesda system for reporting allowed precise cytological diagnosis. It represents standardization and reproducibility in reporting thyroid cytology with improved clinical significance and greater predictive value. Nature of the disease, experience of cytopathologist, and understanding of certain limitations determine its diagnostic utility.

Introduction: There is a growing clinical awareness about the influence of gut–lung axis on lung injury and coexisting manifestations of disease processes in both the intestine and lungs. Patients of chronic lung diseases such as chronic obstructive pulmonary disease (COPD) and asthma very often present with coexistent gut symptoms. In the present study, we have tried to establish the correlation of severity of pulmonary pathology of COPD and asthma patients with functional gastrointestinal (GI) symptoms of the patients. Materials and Methods: This is a prospective, questionnaire-based study comprising patients with asthma and COPD. After following strict inclusion and exclusion criteria, a total of 200 patients (100 patients of bronchial asthma and 100 patients of COPD) were included in the study. Functional GI symptom questionnaire [Annexure 1-Bowel Disease Questionnaire] is based on ROME III diagnostic criteria. On the basis of GOLD (Global Initiative for Obstructive Lung Disease) guidelines, COPD patients were divided into 4 categories (mild - GOLD 1, moderate – GOLD2, severe – GOLD3 and very severe – GOLD4). Asthma patients were divided into three categories (well controlled, partly controlled, uncontrolled) on the basis of GINA (Global Initiative for Asthma) guidelines. Results: Highest percentage of patients with maximum GI symptoms was found in “GOLD-4” group among COPD patients and “uncontrolled” group among asthma patients. Highest percentage of patients with least GI symptoms was found in “GOLD-1” group among COPD patients and “well controlled” group among asthma patients. Conclusion: We can conclude from our study that the phenomenon of gut–lung axis not only exists but also the severity of symptoms of one system (gut) carries a high degree of concordance with severity of other (lung).

Background: Adolescence, a psychologically vulnerable stage of life, when coupled with stressful environment such as institutional homes, may result in high psychiatric morbidity. These psychiatric disorders including depression are detrimental to the psychological development in adolescents. Aims and Objectives: The objectives of the study were to describe and study the extent of depression in adolescent boys and girls living in institutional homes and to study the association between depression and externalizing and Internalizing behaviors among adolescents in institutional homes. Materials and Methods: This cross-sectional descriptive study was done on 150 adolescents staying in institutional homes in Visakhapatnam city. A semi-structured questionnaire was used to collect sociodemographic data. Patient Health Questionnaire was used to screen for Depression. Strengths and Difficulties Questionnaire was used to score for externalizing and internalizing behaviors. Statistical analysis was done using descriptive statistics and tests of association. P < 0.05 was taken as significant. Results: Clinical Depression was found in 19 (12.7%) out of 150 adolescents. Subclinical mild depression was found in 19.3% of the sample. Depression was found to be significantly associated with gender and academic performance. Externalizing and internalizing behaviors were positively correlated with depression while prosocial behavior was negatively correlated with depression. Conclusion: Depression has high prevalence in institutionalized adolescents. Those adolescents who show signs of externalizing or internalizing behaviors should be especially screened for depression. Further research should be done to collect more data in this regard and to focus on designing interventions for its prevention, screening, and treatment.

Introduction: Menisci and cruciate ligaments are intra-articular structures of knee, and injury to these structures is common. Morphometric data gained in the study will help in analyzing the variations among humans and correlating it with the possibility, location, and type of injuries as well as better interpretation of structures during magnetic resonance imaging and arthroscopy which will further help in reconstructive surgeries of knee. Materials and Methods: Width and thickness of the medial menisci (MM), lateral menisci (LM), and maximum length and width of anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) were taken on twenty knees. Histological examination of menisci was done. Results: Width of MM was 0.601–0.700 cm at anterior horn (AH) in 45% of cases, 1.000–1.500 cm at posterior horn (PH) in 60% of cases, and 1.000-1.500 cm at body in 30% of cases. Thickness of MM at AH (45%) and PH (40%) was 0.401–0.500 cm and at body (35%) was 0.501–0.600 cm. Width of LM at AH (35%) was 0.801–0.900 cm, at PH (45%) was 0.901–1.000 cm, and at body (35%) was 1.000–1.500 cm. Thickness of LM at AH (45%) was 0.301–0.400 cm, at PH (50%) was 0.401–0.500 cm, and at body (40%) was 0.601–0.700 cm. Length of ACL in maximum percentage of specimens (55%) was 3.01-3.50 cm. Width of ACL in 25% specimens were 0.801-0.900 cm and in another 25% specimens were 1.001-1.500 cm. Length of PCL in maximum percentage of specimens ( 50 %) was 3.51-4.00 cm. Width of PCL in 80 % of specimens was 1.001-1.500 cm. Histological examination of menisci showed fibrocartilage (outer two-thirds) and hyaline cartilage (inner one-third). Orientation of fibers was circumferential with intermingled radial fibers. Fibroblasts, chondrocytes, and unclassified cells were arranged as single, paired, or in rows along the direction of fibers except in hyalinized part. Blood vessels were present toward the peripheral part. Conclusions: The maximum width of MM was at PH and for LM it was at the body. Maximum thickness was at the body for MM as well as LM. Width of PCL was more as compared to ACL.

Introduction:Klebsiella pneumoniae (K. pneumoniae) is an important opportunistic pathogen causes serious community and hospital-acquired infections, which is highly resistant to antibiotics. We aimed to determine the frequency of multidrug resistant (MDR) and molecular typing of clinical isolates of K. pneumoniae. Methodology: One hundred isolates of K. pneumoniae were collected from clinical samples in three general hospitals in Kermanshah. The antimicrobial susceptibility and extended-spectrum beta-lactamases (ESBL) production of isolates were determined using disk diffusion and combined disk methods, respectively. The blaCTX-Mgene, class I and II integrons were detected using polymerase chain reaction. The blaCTX-Mpositive isolates were selected for genotyping using pulsed-field gel electrophoresis (PFGE). Results: MDR phenotype was observed in 56% of isolates. The 40% of isolates were ESBL positive and 35 isolates contained blaCTX-M. Class I and II of integrons were detected in 50 (89.2%) and 39 (69.6%) of MDR isolates, respectively. PFGE patterns of K. pneumoniae blaCTX-Mpositive isolates indicated 19 clusters (X1-19) with different genotype patterns. Conclusions: The study findings highlight the concern of circulating MDR strains of K. pneumoniae with blaCTX-Mand class I and II integrons in Kermanshah hospitals. The presence of integrons among isolates may facilitate the spread of new resistance genes in this bacterium. Therefore, surveillance for the spread of MDR strains of this bacterium is recommended in hospitals.

Background: Chronic inflammation and elevated basal metabolic rate (BMR) are established features of sickle-cell anemia (SCA). However, there is little information on the possible impacts of these afore-mentioned features on glycemia and insulin sensitivity status of this group of people. Aim: This study aims to determine the insulin sensitivity status as well the effect of BMR on glycemia in adults with SCA in steady state. Materials and Methods: Fifty participants comprising 30 adults with SCA in steady state and 20 age- and gender-matched apparently healthy adults with hemoglobin genotype AA (HbAA) genotype that served as controls. Anthropometric and clinical indices were obtained using standard methods. After an overnight fast, fasting plasma glucose (FPG), and serum insulin levels were determined using the glucose oxidase method and ELISA, respectively. Indices of insulin sensitivity and β-cell function as well as BMR were appropriately calculated. Results: The mean fasting insulin resistance (IR) index, homeostatic model of assessment of IR (HOMA-IR) and of β-cell function (HOMA2-β%), and mean insulin level were significantly lower while the mean HOMA of insulin sensitivity (HOMA2-S%), quantitative insulin sensitivity check index, inverse of insulin sensitivity (1/FI), glucose-insulin ratio, C-reactive protein (CRP), and BMR was significantly higher in patients with SCA compared with the controls. The mean FPG and insulin levels and the mean values of indices of insulin sensitivity and secretion were not significantly different in SCA patients with elevated BMR compared with SCA patients with lower BMR. In addition, BMR had no significant correlation with FPG and HOMA-IR in patients with SCA. Conclusion: Despite the established chronic inflammation in SCA patients in steady state, they seem to have better insulin sensitivity status but impaired β-cell activity when compared with adults with HbAA. Furthermore, BMR does not have any pronounced effect on glycemic and insulin sensitivity status in SCA patients in steady state.

Aim: This study aims to study the effect of short-term consumption of probiotic yogurt containing Lactobacillus acidophilus La5 and Bifidobacterium lactis Bb12 on salivary Streptococcus mutans count in high caries risk individuals. Materials and Methods: A double-blind randomized control trial was conducted, and 70 high caries risk individuals with a salivary S. mutans count of more than 106 CFU/ml of saliva were followed for 4 weeks. Participants ingested 100 g yogurt containing L. acidophilus La5 and Bifidobacterium lactis Bb12 or yogurt without the two probiotic bacteria once daily at the end of meals for initial 2 weeks. Salivary S. mutans were enumerated in the laboratory by selective culture media. Results: A statistically significant reduction (P < 0.05) of salivary S. mutans was recorded after probiotic yogurt consumption with minimal residual effect, which was in contrast to the controls. Conclusion:L. acidophilus La5 and Bifidobacterium lactis Bb12 present in the yogurt were effective in reducing the S. mutans levels in saliva.

Context: Kv7 potassium channels are expressed in several types of smooth muscles and could mediate physiological responses in the tissues expressed. Flupirtine is an analgesic that acts by opening Kv7 potassium channels. It has been shown to inhibit the contractility of several types of isolated smooth muscle. Aims: This study investigated the ability of flupirtine to inhibit the spontaneous contractility of isolated distal caprine (goat) ureter. Settings and Design: Spontaneous contractility of the isolated goat ureter was recorded using a physiograph. Materials and Methods: The ability of 1, 3, 10, 30, and 90 μM concentrations of flupirtine maleate to inhibit the spontaneous contractility of isolated distal goat ureter was investigated. The ability of the nonspecific potassium channel blocker 4-aminopyridine (4-AP; 1 mM) and the specific Kv7 channel blocker XE-991 (100 μM) to reverse the inhibitory effect of flupirtine on ureteric contractility was also investigated. Statistical Analysis Used: Both parametric and nonparametric statistical tests were used. Results: At 10, 30, and 90 μM concentrations, flupirtine significantly inhibited the spontaneous contractility of the isolated goat ureter. The EC50of flupirtine for a contact period of 10 min was 17.7 μM. The inhibitory effect of flupirtine on ureteric contractility was significantly reversed by 4-AP and XE-991. Conclusions: Flupirtine inhibits the spontaneous contractility of the isolated goat ureter by opening Kv7 channels.

Here, we present a rare case of unilateral fibromatosis colli of the sternocleidomastoid in an infant with contralateral clavicle fracture after assisted vaginal delivery. We also try to reason that because of right sternocleidomastoid tension, the fracture in the right clavicle was avoided, and because of left-sided clavicle fracture, left sternocleidomastoid muscle did not form pseudotumor as there was release of tension in these muscle fibers after fracture.

Mucormycosis is a rare but often fatal fungal infection caused by a group of fungus known as the Mucorales. This fungus can cause varieties of infections in human beings, especially in an immunocompromised condition. According to various studies, the mortality rate ranges from 10% to 100% depending on the location and site of infection accompanied by underlying diseases. Rhinomaxillary involvement is the most common form of mucormycosis predominantly occurring in patients with uncontrolled diabetes. Necrosis of the maxilla in patients with rhinomaxillary form is less evident as the maxilla is richly vascular, but in case of immunocompromised status, it becomes a common clinical finding. Due to the necrosis of the maxilla, maggots have been found in the nasal and oral cavity which adds to the deteriorating clinical condition. This case report describes a combined medical, surgical, psychological, and prosthetic approach in effectively managing one such case of rhinomaxillary mucormycosis.

The occurrence of bilateral breast cancer is rare. A second primary in the contralateral breast can either be synchronous or metachronous. Lobular carcinoma of the breast is known for its multicentricity and bilateral spread. The synchronous mixed pattern of carcinoma of the breast has also been reported in the same breast. The family history of breast carcinoma, estrogen receptor negativity, and human epidermal growth factor receptor-2 positivity are risk factors for the development of contralateral breast malignancy. In metachronous, bilateral breast cancer (MBBC) usually a single histological variant is seen at different time periods. However, we report a rare case of MBBC in a 66-year-old female patient with positive family history who had infiltrating lobular carcinoma (ILC) in the left breast followed by infiltrating ductal carcinoma in the right breast after a span of 2½ years, even after undergoing modified radical mastectomy with adjuvant chemotherapy followed by hormonal therapy for ILC of left breast.

Congenital malformations of the lung are extremely rare with an incidence of pulmonary hypoplasia around 1–2/12,000 births. Boyden has categorized three degrees of malformation including (i) agenesis in which there is complete absence of the lung and bronchus and no vascular supply to the affected side, (ii) aplasia in which there is the presence of rudimentary bronchus with the absence of pulmonary parenchyma, and (iii) hypoplasia in which there are variable amounts of bronchial tree, pulmonary parenchyma, and supporting vasculature. Here, we present an incidental case of pulmonary hypoplasia in a young female.

Spontaneous splenic hematoma occurring during pregnancy is a rare entity. It often occurs in preexisting pathology of the spleen such as thalassemia or infectious etiologies such as malaria, typhoid, dengue, or infectious mononucleosis but most commonly after a trauma. The occurrence of splenic hematoma during pregnancy without any underlying cause is rare. Here, we present such a case and the diagnostic dilemma associated with it.